Jakarta, Indonesia – Medical experts have linked an increase in coronovirus cases to Bali’s inaccurate, low-cost rapid antibody test kits that are being used for screening domestic visitors to the Indonesian resort island.
Foreign tourists were banned from entering Indonesia on 2 April, and the plan to reopen Bali to international travelers was lifted this week, resuming domestic air travel on 31 July.
Since then, the island has been welcoming an average of 3,000 domestic tourists every day, mostly to the neighboring islands of Java, the country’s most densely populated province, and the worst affected by the epidemic.
During July and in the first half of August, the number of newly confirmed cases in Bali decreased from 27 cases per day on August 10, with an average of 40 new cases per day for seven days.
But two weeks after the resumption of the domestic voyage, confirmed cases were confirmed on the island Five record breaking days in 198 New cases on 4 September. As of Tuesday there were 6,385 in Bali Confirmed cases and 116 deaths.
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Across the country, the total number of cases was 196,989 with 8,130 deaths..
To enter Bali, visitors are required to present a negative rapid antibody test result not older than 14 days.
They also show no external symptoms of the virus, such as dry cough or fever, but Dr., an epidemiologist who helped formulate Indonesia’s epidemic response for 20 years. Dickey Budiman says the screening protocol probably allowed more cases to enter Bali.
“Rapid antibody test kits do not detect current infections. They only detect if a person has been infected a few weeks or months earlier,” he said.
He also stated that the tests are “not specific” to COVID-19.
“If you tested positive, you could catch a different coronovirus from your dog. For this reason, Australia, England and India all stopped using them, because they are not accurate.”
The World Health Organization in Indonesia has said that the use of antibody tests gives travelers a “false sense of security” with non-reactive results because sensitivity to COVID-19 varies between 34 percent and 80 percent.
The Association of Clinical Pathology and Laboratory Medicine Specialists of Indonesia reports the accuracy of these tests as less than 50 percent.
Budiman says the best way to stop domestic tourists with COVID-19 from spreading the virus in Bali is to change the screening protocol to a polymerase chain reaction (PCR) test – used to return from Indonesian citizens and permanent residents Foreigner known as ‘Gold Standard’.
This is a view shared by Udayan University Professor Gusti Nurah Mahdika, Bali’s most senior virologist.
“I have said since February that rapid antibody tests are not suitable for screening people coming to Bali. It is a cheap solution suitable for screening patients in the hospital, and PCR to confirm if the patient is reactive. Tests need to be done. “Are infected,” he said.
A test response means that the person has antibodies to the virus, but if someone does not react to the test, it does not mean they do not have the virus.
“They are misinterpreting the results,” Maharadika added. “Those with nonconsequential results should have PCR tests on the spot or quarantine. ”
Ahmed Utomo, a Jakarta-based independent molecular biological consultant specializing in the diagnosis of lung infections, agreed that the results of rapid antibody tests in Indonesia were being misinterpreted.
“If a person is reactive, they are building their antibodies and I would feel safer around them than those whose test results are inactive,” he said.
Utomo also stated that testing for COVID-19 with rapid antibody tests is a poor policy.
“They are not generally used for screening. They are an epidemiological tool used to study disease burden in specific areas. I don’t know why they emphasize them.”
But he is also skeptical about whether the surge in confirmed cases in Bali is related to trials. He thinks that those who fail to follow guidelines designed to stop the spread of the virus are more likely to jump.
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“Like East Java where cases are increasing, it’s probably about public behavior,” he said.
“People are holding public demonstrations, denying any kind of tests, refusing to wear masks and not practicing physical disturbances because they don’t believe the disease is real. And it’s totally It is not their fault.
“About 80 percent of cases in Indonesia are asymptomatic. Of the remaining 20 percent, only half are in intensive care and the public does not see them. It’s not that people are falling on the street.”
Raising the economy first
Authorities in Indonesia have not explained why concerns about reliability were given – rapid antibody testing is used as a requirement for travel.
The Bali provincial government, the Bali Disaster Mitigation Agency and the Department of Health referred the inquiry to the Bali COVID-19 task force, which referred the inquiry back to the Department of Health.
The National COVID-19 Task Force and National Disaster Management Agency in Jakarta did not immediately respond to Al Jazeera’s questions.
On Monday, Bali announced that as part of its effort to contain the epidemic, it would begin to pay a fine of 100,000 rupees ($ 6.77) on residents seen without a face mask.
The epidemiologist, Budiman, believes the government took this decision because “they had already bought millions of rapid antibody tests from China and wanted to use the stock”.
But others say the use of tests is linked to the need to propel the economy.
Writing, conversation, in academic website Experts Tim Mann and Tim Lindsay of the University of Melbourne Indonesia said the government was concerned that the struggling economy could “lead to more criticism of dealing with the crisis – and possibly social unrest”.
Economic impact has been felt, particularly in Bali, where estimates show at least half, and perhaps 80 percent of GDP is associated with tourism.
On September 1, President Joko Widodo acknowledged the “biggest economic contraction Bali,” Indonesian province, with a negative growth of 11 percent.
Allowing domestic tourists to return to Bali is going to provide a much needed economic lifeline for the island.
Antibody testing costs about $ 10 per person.
But PCR tests cost between $ 83 and $ 179, making them prohibitively expensive for many middle-class Indonesians, who make up most of the country’s domestic tourism market.
“A family could have cost $ 1,000 if everyone had to take a PCR test,” a hotel executive in Bali said on condition of anonymity.
“In that case, no one will come.”